Provider Demographics
NPI:1063995934
Name:BASTING, AMANDA JEAN (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JEAN
Last Name:BASTING
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 ROUTE 39 S
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:CT
Mailing Address - Zip Code:06784-2317
Mailing Address - Country:US
Mailing Address - Phone:845-797-8998
Mailing Address - Fax:
Practice Address - Street 1:572 US 6
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541
Practice Address - Country:US
Practice Address - Phone:845-519-2295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004650235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist